Anti-Phospholipid Syndrome

ANTI-CARDIOLIPIN ANTIBODIES
 Antibodies tested ?

1. aCL IgG1
2. aCL IgM
3. Beta-2 GP12
4. Lupus Anti-Coagulant (LAC)

(1.aCL = Anti-Cardiolipin Antibody)

(2.GP = Glycoprotein)
 Anti-Phospolipid Syndrome

 Hypercoagulable state
 Both Arterial & Venous Thrombosis

MCQ point
APS and Homo-cysteinaemia
- Cause both Arterial and Venous thrombosis
 Only Venous Thrombosis

Conditions:-
1. Protein C deficiency
2. Protein S deficiency
3. Anti-thrombin – III deficiency
4. Factor- V Leiden mutation
5. Prothrombin Mutation

*No Arterial Thrombosis.

 Learning Point

Conditions causing venous thrombosis

Conditions causing both arterial and venous
thrombosis
 APS

1. Primary
Disease per se (No underlying disease)

2. Secondary
Underlying cause like
- SLE**
- Dermatomyositis etc.

**Major cause for APS

 Important Clinical Features - APS

1.Recurrent pregnancy loss

2.Thrombosis
- arterial
-TIA,Ischemic CVA, Stroke in young
- venous
- CVT1,DVT,Mesenteric Thrombosis,
Pulmonary Embolism
 Important Clinical Features – APS
Continued....

3.Neurological Symptoms
- Chronic Headache
 Dementia
 Migraine
 Seizures

4.Damage to Heart Vessels

5.Bleeding (Paradoxical)
 Risk Factors - APS

 Women> Men (like SLE)

 Infections predispose
- Syphilis, HIV, Lyme disease, Heapatits C
 Drugs like
- Hydralazine

Additional points
APS – most commonly acquired thrombophilia
There are SAPPORO Criteria (Read)
 Learning Point

 Criteria/Classification Must be learnt well

 Foetal morbidities/abortions etc. – usually after 10th
week of pregnancy – APS.

 ASSIGNMENT
 *READ SAPPORO Criteria
 Tough Questions – Many? Why ?

Tougher questions
300 100
Questions Comparatively - To get in first 5000 ranks in
Easier
India, one has to get above
800 marks.
100
100 Fairly  Wish to see you there & You
moderate
TOUGH
will be there.
 Other Criteria/Classifications

*More important – should have some idea.

*READ
1. APACHE-II Criteria
2. ROME-II Criteria
3. ACR Criteria
4. LIGHT Criteria
5. DUKE Criteria
6. CHAPEL-HILL Consensus
7. NYHA Classification
8. CHILD-PUGH Classification (Liver Disease)
9. POSER Criteria ,McDonald Criteria – Multiple Sclerosis
10. OSSERMAN’S Classification (latest April 2001)
 Deviation from APS? – Reverting back

 Duckett-Jones Criteria

APS
*Remember – Can have the
following subsets
Malignancies too have
increased ACL antibody
– may cause increased CAPS SNAPS
(Catastrophic APS) (Seronegative APS)
THROMBOSIS
 Treatment of APS

 Primarily – ANTICOAGULATION
-PT/INR – Targeted to INR – (2-3)
 Important Questions

Q.30 Year old lady with history of 3 abortions after 10

weeks come with history of Amenorrhoea since 6
weeks
 ACL antibodies positive?
 Howto anticoagulate?
 When to start ?

 USG shows cardiac activity in foetus

 How will you manage this patient ?
 Answer

Once Foetal
activity is seen

Start Coagulation
OR UnFractioned
with Low
Heparin (UFH)
Molecular Weight
Heparin (LMWH)

Continue till end of

Pregnancy &
Continue 6-8 weeks
post pregnancy
 Dear Friends....

 Study Well
 Relevant Points
 Read/Write – 24hours
 Extra material sent will motivate you further to read
your text books
 Do not waste time
 If you have not started Textbooks,Marrow etc.., DO
IT NOW especially 2016,2017 batches.
 2015 – assuming you have already started taking
courses
Best wishes....

Dr. Vishal Marwaha

Principal,
Amrita School Of Medicine
AIMS, Kochi.